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The Relationship Between Asymmetric Dimethylarginine and Ankle-Brachial Index With the Severity of Diabetic Foot Ulcers Mardia, Indra Kusuma; Santi Syafril; Brama Ihsan Sazli
Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI) Vol. 7 No. 4 (2025): Journal of Endocrinology, Tropical Medicine, and Infectious Disease (JETROMI)
Publisher : TALENTA Publisher, Universitas Sumatera Utara

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.32734/jetromi.v7i4.19466

Abstract

ABSTRACT   Introduction: Approximately 50% of inpatient cases for diabetic complications are diabetic foot ulcers (DFU). Peripheral artery defect is one of the mechanisms that is characterized by increased asymmetric dimethylarginine (ADMA). Severe diabetic foot ulcers are found in populations with low ankle-brachial index (ABI) values. This study aims to find the relationship between ADMA and ABI in predicting risk for DFU. Methods: An Observational study with a cross-sectional method was conducted at Adam Malik Hospital, Medan collaboration with the Clinical Laboratory from the Faculty of Medicine, Universitas Sumatera Utara. Forty-two patients with DFU from September 2023 to April 2024 were registered with the following information: anthropometric, gender, history of drug use, comorbidities, ABI, ADMA, complete blood count, lipid profile, and fasting blood glucose. Results: In grade II DFU, the average ADMA value was 87.6 ng/dl, grade III 231.3 ng/dl, grade IV 444.9 ng/dl, and grade V 652.3 ng/dl. ABI value using Sokoye classification shows grade II DFU has an average ABI value of 1.08 (Normal), grade III 0.74 (Mild), Grade IV 0.61 (Moderate), and grade V 0.5 (Moderate). There is a significant relationship between the severity of DFU (Wagner scale) and ADMA levels (P = 0.001) and  ABI values ​​(P = 0.001). There is a relationship between ADMA and ABI values with DFU (P = 0.001). Conclusion: There is a significant relationship between the severity of DFU (Wagner scale) and ADMA levels (P = 0.001) and  ABI values ​​(P = 0.001). There is a relationship between ADMA and ABI values with DFU (P = 0.001). Keywords: Diabetic foot ulcer, Asymmetric dimethylarginine, Ankle-brachial index       ABSTRAK   Pendahuluan: Sekitar 50% kasus rawat inap untuk komplikasi diabetes adalah diabetic foot ulcers (DFU). Cacat arteri perifer adalah salah satu mekanisme yang ditandai dengan peningkatan asymmetric dimethylarginine (ADMA). Ulkus kaki diabetes parah ditemukan pada populasi dengan ankle-brachial index (ABI) values. Penelitian ini bertujuan untuk mengetahui hubungan antara ADMA dan ABI dalam memprediksi risiko untuk DFU. Metode: Studi Observasional dengan metode cross-sectional dilakukan di Rumah Sakit Adam Malik Medan bekerja sama dengan Laboratorium Klinik dari Fakultas Kedokteran, Universitas Sumatera Utara. Empat puluh dua pasien DFU dari September 2023 hingga April 2024 terdaftar dengan informasi dari antropometri, jenis kelamin, riwayat penggunaan narkoba, komorbiditas, ABI, ADMA, hitung darah lengkap, profil lipid, dan glukosa darah puasa sebagai berikut.. Hasil: Nilai ADMA rata-rata DFU kelas II: 87,6 ng/dl, grade III: 231,3 ng/dl, grade IV: 444,9 ng/dl, dan grade V: 652,3 ng/dl. Nilai ABI menggunakan klasifikasi Sokoye menunjukkan DFU grade II memiliki nilai ABI rata-rata 1,08 (Normal), grade III 0,74 (Mild), Grade IV 0,61 (Moderate), dan grade V 0,5 (Moderate). Terdapat hubungan antara tingkat keparahan DFU (skala Wagner) dengan kadar ADMA (P = 0,001) dan nilai ABI (P = 0,001). Ada hubungan antara nilai ADMA dan ABI dengan DFU (P = 0,001). Kesimpulan: Ada hubungan antara tingkat keparahan DFU (skala Wagner) dengan kadar ADMA (P = 0,001) dan nilai ABI (P = 0,001). Ada hubungan antara nilai ADMA dan ABI dengan DFU (P = 0,001). Kata kunci: Ulkus kaki diabetik, Asimetris Dimetilarginin, ABI    
Hashitoxicosis: A Case Report Dhini Sylvana; Dharma Lindarto; Santi Syafril; Melati Silvanni Nasution; Dian Anindita Lubis; Stephen Udjung
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 1 (2025): InaJEMD Vol. 2, No. 1
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i1.44

Abstract

Hashimoto Thyroiditis with Grave’s disease/Hashitixicosis is found in some cases, snd this case repirt describes a case of a woman with Hashitoxicosis. A 27 year old woman came to polyclinic on 18th March 2024 with complain of a lump felt, fatique, constipation and weight loss two month before she had weight gain later without any treatment. She was compomentis, BP 149/90 mmHg, HR 87x/i, Wayne index 0, Billewicz score -22. TSH 93.40 mclU/mL and FT4 0.39 ng/dL, anti-TPO >1000 Iau/mL, TRAb 2.46 IU/L. Thyroid ultrasound showed toxic diffuse struma, thyroid scintigraphy revealed enlarge lobes with high and even distribution and capture of radioactivity with conclusion Toxic Diffuse Struma, and cytologic examination showed colloid goiter. Patient was diagnosed as Hashitoxicosis and has been treated with levothyroxine 100 mg once daily. This woman was diagnosed as Hashitoxicosis based on clinical features of hypothyroidism at admission to polyclinic following clinical features of hyperthyroidism initially without any treatment, with laboratory results showed hypothyroidism with the increased of antibody for Hashimoto Thyroiditis and Grave’s disease. Treatment with levothyroxine 100 mg once daily showed the decrease of TSH and normal FT4 level. We report a case of Hashitoxicosis based on clinical features of hypothyroid following hyperthyroidism initially, laboratory, thyroid ultrasound thyroid scintigraphy, and cytologic examination result. Treatment with levothyroxine showed improvement.
Turner Syndrome Mosaicism 46,Xx/45,X with Graves' Disease: A Case Report Faisal Rozi Sembiring; Santi Syafril
‎ InaJEMD - Indonesian Journal of Endocrinology Metabolic and Diabetes Vol. 2 No. 2 (2025): InaJEMD Vol. 2, No. 2
Publisher : PP PERKENI

Show Abstract | Download Original | Original Source | Check in Google Scholar | DOI: 10.66266/inajemd.v2i2.67

Abstract

Turner syndrome (TS) is a condition in females missing the second sex chromosome (45,X) or parts thereof. It is a rare genetic condition with a wide range of clinical stigmata, such as short stature, delayed puberty and infertility, congenital malformations, and endocrine disorders. TS with chromosomal mosaicism (TSM) is a less severe and less frequent form of TS, who has less pronounced signs and symptoms than the classic TS. A 21-year-old woman with TSM and Graves' disease (GD) is reported. She presented with fatigue, sweating, palpitation, tremor, and the absence of menstruation or breast development. Further investigation reveals diffuse enlargement of thyroid gland and hyperthyroidism symptoms. Laboratory testing shows elevated fT4, low TSH, and elevated TSH receptor antibody levels. Previous chromosomal analysis showed a mosaicism: 46,XX,dup(X) (q28q21.2)[36]/45,X[4]. She is then treated with thiamazole and oral beta-blocker.Discussion: Thyroid abnormalities is common in TS, especially in adult females. This including Hashimoto's thyroiditis and GD. But TS presenting with hyperthyroidism is rare, with most of the cases were reported happens in adult females. Mosaicism in TS resulted in less severe signs and symptoms than the classic TS. Therefore, based on the variabilities, it is often undetected. We reported a rare case of TSM with GD. We observed that mosaicism in this TS patient resulted in less severe GD symptoms, and the response to conventional treatment with thiamazole and oral beta-blocker was satisfactory.